SARS-CoV-2感染后抗OJ抗体阳性的抗合成酶综合征:病例报告和文献综述。

IF 2.1 Q3 RHEUMATOLOGY BMC Rheumatology Pub Date : 2024-08-29 DOI:10.1186/s41927-024-00406-6
Robin Sia, Benjamin Massouridis, Nicholas Ngan Kee, Bryan Yong, Catriona Mclean, Sian Campbell
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引用次数: 0

摘要

背景:COVID-19 可诱发全身性炎症反应,临床表现各异。与各种病毒类似,COVID-19 也与自身免疫性疾病的发病机制有关。本文强调了包括 SARS-CoV-2 病毒在内的感染有可能诱发原有的自身免疫性疾病恶化,甚至有可能在易感人群中揭示新的自身免疫性疾病,尤其是抗合成酶综合征(ASSD)。虽然有其他关于感染 SARS-CoV-2 后出现抗合成酶综合征的病例报道,但我们在此首次报道了一名感染 SARS-CoV-2 后新诊断出抗 OJ 阳性的抗合成酶综合征患者:病例介绍:这是一例 70 岁男性急诊病例,因近期感染 COVID-19 导致呼吸困难加重。胸部 CT 显示肺部纤维化病变,与常见的间质性肺炎(UIP)模式一致。尽管从 COVID-19 病症中恢复过来,但患者随后出现了近端肌病,进一步评估时出现颈部屈曲无力,肌酸激酶(CK)持续升高。通过 MRI-STIR 和肌肉活检发现,肌炎自身抗体呈抗 OJ 自身抗体强阳性,从而进一步确诊。患者接受了为期 3 天的 1 克脉冲甲基强的松龙治疗,并长期口服强的松龙断奶。鉴于患者有多种内脏器官表现,医生给他注射了 2 克/千克的负荷免疫球蛋白,分两天给药。此外,他的嘌呤代谢正常,因此开始使用并升级到全剂量硫唑嘌呤,至今仍处于临床缓解期。至少有 267 例风湿病与 SARS-CoV-2 感染和接种 COVID-19 疫苗有关。我们在 PubMed 上进行了文献检索,以确定与 SARS-CoV-2 感染相关的肌炎病例报告的数量。我们发现有 3 篇病例报告符合我们的纳入标准。我们还进一步检索了有关 ASSD 诊断方法和治疗的文献:结论:尽管 SARS-CoV-2 感染本身可直接导致病毒性肌炎,但本病例报告强调了通过上述多种机制引发炎症性肌炎的可能性。因此,需要进一步研究探讨 SARS-CoV-2 感染与炎症性肌病发病率之间的关系和病理生理学。
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Anti-OJ antibody-positive anti-synthetase syndrome following SARS-CoV-2 infection: a case report and literature review.

Background: COVID-19 can induce a systemic inflammatory response with variable clinical manifestations. Similar to various viruses, COVID-19 has been implicated in the pathogenesis of autoimmune diseases. This article highlights the potential for infections including the SARS-CoV-2 virus to induce exacerbations of pre-existing autoimmune diseases or even potentially unmask de novo autoimmune diseases in particular anti-synthetase syndrome (ASSD) in predisposed individuals. Although there are other case reports of ASSD following SARS-CoV-2 infection, here we present the first reported case of a gentleman with a newly diagnosed anti-OJ positive anti-synthetase syndrome following SARS-CoV-2 infection.

Case presentation: Described is a case of a 70-year-old man presenting to the emergency department with worsening dyspnea in the context of a recent COVID-19 infection. CT-chest revealed changes suggestive of fibrotic lung disease, consistent with usual interstitial pneumonitis (UIP) pattern. Despite recovery from his COVID-19 illness, the patient subsequently developed proximal myopathy with cervical flexion weakness on further assessment with persistently elevated creatinine kinase (CK). Myositis autoantibodies found a strongly positive anti-OJ autoantibody with MRI-STIR and muscle biopsy performed to further confirm the diagnosis. The patient received pulse methylprednisolone 1 g for 3 days with a long oral prednisolone wean and in view of multiple end-organ manifestations, loading immunoglobulin at 2 g/kg administered over two days was given. In addition, he was then commenced and escalated to a full dose of azathioprine given a normal purine metabolism where he remains in clinical remission to this date. At least 267 cases of rheumatic diseases has been associated with SARS-CoV-2 infection as well as COVID-19 vaccination. A literature search on PubMed was made to determine the amount of case reports describing myositis associated with SARS-CoV-2 infection. We found 3 case reports that fit into our inclusion criteria. Further literature searches on diagnostic approach and treatment of ASSD were done.

Conclusion: Although SARS-CoV-2 infection itself can cause a directly mediated viral myositis, this case report highlights the possibility of developing virus-triggered inflammatory myositis through multiple aforementioned proposed mechanisms. Therefore, further studies are required to explore the relationship and pathophysiology of SARS-CoV-2 infection and the incidence of inflammatory myopathies.

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来源期刊
BMC Rheumatology
BMC Rheumatology Medicine-Rheumatology
CiteScore
3.80
自引率
0.00%
发文量
73
审稿时长
15 weeks
期刊最新文献
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